A West Australian coroner has found that had a six month old baby been taken to hospital sooner, her life could have been saved.

Six month old Allegra Amelie Scafidas fell ill in April 2010. She was feverish, vomiting and having breathing difficulties. Her concerned mother called the free telehealth service, Healthdirect to speak to a nurse at 9.30pm on April 28, 2010. Nurse Dianne Ison then tried to diagnose the baby over the phone, deducing that she probably had a stomach virus and to call back if the Allegra’s temperature hit 39.5 degrees.

The following morning Allegra had developed a yellow tone to her skin, had a rash on her thighs, was turning blue around her mouth and grunting. She was rushed to hospital but tragically and needlessly died a week later as a result of pneumococcal meningitis.

Coroner’s findings

Coroner Dominic Mulligan said, “Had Allegra been taken to hospital on 28 April 2010, it is likely she would have survived, although the bacterial infection may have caused her significant harm. Nurse Ison clearly left Ms Vo [Allegra's mother] with the impression that Allegra had a tummy virus and that medical intervention was unwarranted. She trusted what she was told and, having no medical background herself, had no reason to argue with the advice she had been given.”

Another ‘stay home’ diagnosis

Ms Vo is not the only parent to receive inaccurate advice from a phone health service.

Sara’s husband fell ill with suspected meningitis in July 2012. He was immediately hospitalised leaving a worried Sara at home with her two young children, a toddler and Zoe, a 3 month old baby. A day later Zoe fell ill. Concerned, Sara rang the hospital where her husband had been admitted to report the baby’s symptoms.

“I called the hospital and they put me through to a free nurse phone line. The telehealth nurse told me that I was being silly, thinking that Zoe could have meningitis just because my husband was in hospital with a suspected case. She said because Zoe was projectile vomiting we should stay at home. I was advised to feed her little amounts of breast milk every half hour or so to keep her fluids up and see how she was in the morning. It was only because I decided to ignore the nurse and call an ambulance, then insisted on staying at the hospital so they could watch her, that we got the right treatment.”

Sara’s husband and baby Zoe were both eventually diagnosed with viral meningitis and recovered quickly once they were hospitalised and treated correctly.

The flipside

But while children who should be admitted are being told to stay home, some doctors say that too many conservative ‘go to hospital’ over-the-phone diagnoses are putting more pressure on hospitals and resulting in needless visits:

“When you’re on the phone you can’t see the patient so you have to err on the side of conservatism,” Fremantle emergency doctor, Professor Nagree said.

Improve and inform

That Healthdirect improve the content of its guidelines and the training given to registered nurses undertaking triage.

That Healthdirect nurses inform callers about the nature of the service and expressly advise them that they are unable to give a diagnosis over the phone.

Allegra’s parents speak out

It’s heartbreaking to consider what baby Allegra’s parents have endured. Any parent who has had a sick child knows how confusing and upsetting it is, and how difficult it can be to know the best way to help and when to seek medical attention.

A statement released on behalf of Allegra’s parents Elias Scafidas and Nhon Vo reads, “Although we see the merits of a telehealth system, the system is by no means infallible, and without constant and mandated feedback from users such as ourselves, such a system will again fail the most vulnerable. Our sincere wish is that some good and enduring benefit is derived from Allegra’s tragic death.”

When to go to hospital?

Despite many reports in the media today of positive experiences with telehealth services (such as on ABC’s Breakfast show this morning), it’s really a case of parents beware. These services are not always accurate and when your child’s wellbeing is on the line, it’s always prudent to err on the side of caution.

If you are concerned about your child’s health, seek face-to-face medical advice immediately. If it’s late at night, go to your nearest hospital or after-hours medical centre. Better to be labelled an over-protective parent than risk your child’s health because you didn’t want to ‘bother’ the people in emergency or at your local surgery.

Allegra’s tragic death shows that one night without the correct treatment can make a terrible difference.

Have you had any experiences with Healthdirect or telehealth services? We’d love you to share your story (good or bad) in the comments below.